Could hematologic parameters be useful biomarkers for the diagnosis of endometriosis?

OBJECTIVES: The objective of this study was to evaluate the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR), lymphocyte­to­monocyte ratio (LMR), and mean platelet volume (MPV) in patients with endometriosis as compared with healthy controls. BACKGROUND: Currently, no non-invasive diagnostic test of endometriosis has been implemented in clinical practice. METHODS: A total of 121 women with endometriosis and 136 controls participated in this retrospective study. The extent of the disease in the patients with endometriosis was determined using the American Society of Reproductive Medicine revised classification. Sensitivities and specificities of NLR, LMR and MPV were evaluated by receiver-operating characteristic (ROC) analysis. RESULTS: Patients with endometriosis had higher neutrophil counts, white blood cell (WBC) levels, NLR, MPV, and lower lymphocyte count and LMR than the control group. The cut-off values were found to be 1.6 for NLR at 87.6 % sensitivity and 44.8 % specificity and 8 for MPV at 75.2 % sensitivity and 68.4 % specficity. For LMR, the cut-off value was 5.6 with 66.1 % sensitivity, 50 % specificity. Patients with stages III or IV had significantly lower MPV (p = 0.039) and LMR levels (p = 0.016) than patients with stages I or II. CONCLUSION: NLR, LMR, and MPV may be used to distinguish patients with endometriosis from controls (Tab. 4, Fig. 4, Ref. 37).

Evaluation of the academic productivity of the top 100 worldwide physicians in the field of otorhinolaryngology and head and neck surgery using the Google Scholar h-index as the bibliometrics ranking system.

OBJECTIVE: The top 100 physicians of otorhinolaryngology and head and neck surgery worldwide were investigated using the Google Scholar h-index. METHOD: Although there are various bibliometrics ranking systems that present the academic quantity and quality of scientists' published articles, the h-index is the most popular and widely accepted. In this study, Google Scholar was used to search all the keywords involving all the subspecialties of otorhinolaryngology and head and neck surgery, with the aim of identifying as many physicians as possible. Obtaining the Google Scholar h-index and citations is not possible for scientists who do not have Google Scholar accounts. Thus, only those with Google Scholar accounts were included. RESULTS: The average h-index of all 100 physicians enrolled in the study was 37.83, with a range of 25-81. CONCLUSION: The current study details the academic impact of otorhinolaryngology and head and neck surgery physicians worldwide based on the Google Scholar h-index.

Interobserver reliability of sonographic fetal biometry in second trimester maternal serum screening.

PURPOSE: To examine the interobserver variability for fetal biometry parameters and to investigate whether this variability affects the second-trimester maternal serum screening test (STMSS) results. MATERIALS AND METHODS: A total of 60 singleton pregnancies who were scheduled for STMSS were investigated. Two experienced sonographers performed all examinations at the same visit. The risk calclations of screening were performed according to the each operator's biometric measurements separately. Interobserver variability in measurements of fetal biometrics and the effect of this interobserver variability on the screening results were assessed. RESULTS: inter-observer reliability for biparietal diameter (BPD) and femur length (FL) were 0.904 and 0.888 (p < 0.00 1), respectively. interobserver reliability coefficients for trisomy 21, trisomy 13/18, and neural tube defect were 0.887, 0.999, and 0.920 (p < 0.0001), respectively. CONCLUSION: The present results demonstrate that the interobserver reliability and agreement of ultrasound measurements of fetal biometry in cases of routine prenatal screening are highly reliable.

Evaluation of transiently evoked otoacoustic emissions and auditory brainstem responses in patients with multiple sclerosis.

Multiple sclerosis (MS) is an inflammatory and demyelinating disease of the central nervous system. This prospective study was planned to evaluate these changes through brainstem evoked response audiometry (BERA) latency abnormalities and otoacoustic emissions (OAE). This study was performed between September 2009 and May 2010. A total of 160 recordings of BERA and OAE were examined, which were obtained from 80 ears of 40 participants. Twenty of these were MS patients and 20 were healthy volunteers in the control group. Mean ages of the MS group and the control group were 31.3 ± 4.73 and 30.95 ± 4.83 years, respectively. In patients' right ears in the MS group, the wave I, III, and V peak latencies and the I-V interpeak latencies were significantly prolonged compared to those in the control group. In patients' left ears in the MS group, the wave I, III, and V peak latencies and the I-III and I-V interpeak latencies also were significantly prolonged compared to those in the control group. There were no significant differences between the right and left ears for each group regarding wave latencies and intervals. In the MS group, the average of the interaural difference for I-V interpeak latency was significantly prolonged compared to that in the control group. The most reliable diagnostic method in MS is magnetic resonance imaging (MRI). However, sometimes plaques in the central nervous system may not be displayed. The pathologic process may exist and continue before these plaques become detectable on MRI, but electrophysiologic testing such as BERA can demonstrate these changes.

Bone metastasis in endometrial cancer: evaluation of treatment approaches by factors affecting prognosis.

OBJECTIVE: The purposes of this study were to present an endometrial cancer case with a first sign of bone metastasis, and to reveal factors affecting survival and the appropriate treatment methods for bone metastases. MATERIALS AND METHODS: A total of 101 case reports that presented with bone metastasis of endometrial cancer were reviewed in this study. RESULTS: Survival time in the patients without surgical treatment for bone metastasis was found to be 12 months (95% CI = 5.89 - 18.10) and 42 months in patients who underwent surgical treatment in addition to one or more of chemo-radio-hormonotherapies (95% CI = 16.58 - 67.41) (p = .006). Histological type of cancer, extra-osseous metastasis, and lack of surgery were the factors significantly affecting survival (p = 0.012, p = 0.002, and p = 0.038, respectively). CONCLUSION: Histological type and the presence of extra-osseous involvement are important prognostic markers in endometrial cancer patients with bone metastasis. It may be appropriate to implement combination therapies including surgery in the treatment of bone metastases.

Reproductive outcomes following hysteroscopic resection of endometrial polyps of different location, number and size in patients with infertility.

We aimed to assess the pregnancy rates after hysteroscopic polypectomy in infertility patients with endometrial polyps and to compare pregnancy rates among subgroups with polyps of different location, size and number. All patients who underwent hysteroscopic evaluation which revealed endometrial polyps were included. Patients with any intrauterine pathology other than polyp and those undergoing frozen embryo transfer (ET) cycles were excluded. Patients were evaluated according to polyp location, size and number. Rates of ß-hCG positivity and clinical pregnancy were compared. Clinical pregnancy rates after polypectomy was 41.7% for multiple polyps, 30.8% for isthmus zone polyps, 28.6% for anterior wall polyps, 27.3% for cornual zone, 22.2% for posterior uterine wall polyps and 11.8% for fundal polyps (p = 0.532). There appears no difference regarding reproductive outcomes after hysteroscopic resection of polyps situated in different intrauterine locations. Similarly, chance of conceiving seems not to change after hysteroscopic treatment of polyps of different size and number.

Is there any effect of oocyte count retrieved in the OPU procedure on pregnancy outcomes?

We aimed to investigate whether the number of oocytes retrieved during ovum pick-up has any effect on pregnancy outcomes when using the gonadotropin-releasing hormone or GnRH long agonist or antagonist protocols. A retrospective study was conducted between 2012 and 2014. The patients were grouped according to the number of oocytes retrieved at ovum pick-up; < 10 oocytes (Group 1), 10-14 oocytes (Group 2) and ≥ 15 oocytes (Group 3). Biochemical pregnancy rates were compared among the three groups. Statistical analysis was performed using one-way ANOVA test for continuous variables and chi-square test for categorical variables. In total, 825 treatment cycles were included in the study. Groups 1, 2 and 3 consisted of 514, 206 and 105 patients, respectively. There was no difference among the three groups regarding biochemical pregnancy rates (22.8%, 28.6% and 28.6%; p = 0.166, respectively). The results of our study suggest that the number of eggs retrieved has no effect on pregnancy outcome in assisted reproductive technology treatment.

The efficacy of the systemic methotrexate treatment in caesarean scar ectopic pregnancy: A quantitative review of English literature.

To determine the efficacy and safety of primary medical treatment with systemic methotrexate (MTX) in caesarean scar ectopic pregnancy, we conducted a Medline/PubMed search on the relevant English literature from January 1978 to January 2012. The search yielded 27 publications of 40 cases of caesarean scar ectopic pregnancy. The literature search showed a very liberal use of systemic MTX treatment with unfavourable outcomes, although the major determinant of the clinical efficacy was found in here to be ß-hCG level together with embryonic cardiac activity (ECA) status. A caesarean scar ectopic pregnancy presented with a serum ß-hCG concentration of ≤ 12,000 mIU/ml (odds ratio, OR 5.68, 95% confidence interval, CI, 1.37-23.48) and absence of ECA (OR 4.80, 95% CI, 1.14-20.08) was found to be associated with higher efficacy rate of primary systemic MTX treatment. Administration of primary systemic MTX treatment was found to be ideal for a caesarean scar ectopic pregnancy presented before 8 weeks' gestation, with a ß-hCG concentration of ≤ 12,000 mIU/ml together with an absent ECA (OR 14.52, 95% CI, 2.36-89.09).

Evaluation of the accuracy of ultrasonography fetal weight estimation models; assessing regression formulae in a Turkish population.

In this study, we aimed to evaluate the accuracy of fetal weight prediction, to investigate the validity of sonographic fetal anthropometric parameters in a Turkish population and to assess the most commonly used sonographic formulas for estimation of fetal birth weight. Our retrospective, cross-sectional study included 126 singleton deliveries between June 2010 and January 2011, at the Department of Obstetrics and Gynecology of the GATA Haydarpasa Training Hospital. Ultrasonography measurement results were applied to nine different fetal weight estimation formulas. Mean error, mean absolute error, mean percentage error and mean absolute percentage error rates were calculated. Under- or overestimation rates and correlation coefficients were also calculated. Fetal biparietal diameter (BPD) and abdominal circumference (AC) were significantly correlated with the actual birth weight and the power analysis for both parameters was calculated as 81%. The highest correlation coefficients in our general population were those of the F1 (Hadlock 1) and F2 (Hadlock 2) models. The highest mean percentage error was detected on F8 (Merz 2) model. Fetal weight estimation modalities were observed to give the best results in a weight range of 3,000 and 3,500 g. Regression formulae used in our population, in general, tended to underestimate, however Hadlock 1 and 2 formulations provided the most accurate results. The Hadlock 1 formula estimated the closest to the actual birth weight in fetuses expected to be born under 3,000 g or over 3,500 g.

Deconvolution of high rate flicker electroretinograms.

Flicker electroretinograms are steady-state electroretinograms (ERGs) generated by high rate flash stimuli that produce overlapping periodic responses. When a flash stimulus is delivered at low rates, a transient response named flash ERG (FERG) representing the activation of neural structures within the outer retina is obtained. Although FERGs and flicker ERGs are used in the diagnosis of many retinal diseases, their waveform relationships have not been investigated in detail. This study examines this relationship by extracting transient FERGs from specially generated quasi steady-state flicker and ERGs at stimulation rates above 10 Hz and similarly generated conventional flicker ERGs. The ability to extract the transient FERG responses by deconvolving flicker responses to temporally jittered stimuli at high rates is investigated at varying rates. FERGs were obtained from seven normal subjects stimulated with LED-based displays, delivering steady-state and low jittered quasi steady-state responses at five rates (10, 15, 32, 50, 68 Hz). The deconvolution method enabled a successful extraction of "per stimulus" unit transient ERG responses for all high stimulation rates. The deconvolved FERGs were used successfully to synthesize flicker ERGs obtained at the same high stimulation rates.

Innovative pattern reversal displays for visual electrophysiological studies.

Pattern Reversal (PR) stimulation is a frequently used tool in the evaluation of the visual pathway. The PR stimulus consists of a field of black and white segments (usually checks or bars) of constant luminance, which change phase (black to white and white to black) at a given reversal rate. The Pattern Electroretinogram (PERG) is a biological potential that is evoked from the retina upon viewing PR display. Likewise, the Pattern Visual Evoked Potential (PVEP) is a biological potential recorded from the occipital cortex when viewing a PR display. Typically, PR stimuli are presented on a Cathode Ray Tube (CRT) or Liquid Crystal Display (LCD) monitor. This paper presents three modalities to generate pattern reversal stimuli. The three methods are as follows: a display consisting of array of Light Emitting Diodes (LEDs), a display comprised of two miniature projectors, and a display utilizing a modified LCD display in conjunction with a variable polarizer. The proposed stimulators allow for the recording of PERG and PVEP waveforms at much higher rates than are capable with conventional stimulators. Additionally, all three of the alternative PR displays will be able to take advantage of advanced analysis techniques, such as the recently developed Continuous Loop Averaging Deconvolution (CLAD) algorithm.

Interactive neuromonitoring methods of cochlea and auditory nerve during induced hypoxia and nerve manipulation.

Methods and instrumentation were developed to monitor cochlea and auditory function during surgery. The system allows real time assessment of the cochlear function during auditory nerve manipulation. A specially designed optic probe, placed on the round window (RW) niche, enables simultaneous acquisition of cochlear blood flow (CBF) and electrocochleogram (ECochG). We developed the acquisition paradigms, signal processing methods and implement them in a computational platform. The neuromonitoring system performs an automatic extraction and analysis of cochlear microphonics (CM), compound action potentials (CAP) and sura mating potential (SP). The system uses envelope detection filters to detect the amplitude of the CM. The CAP signal is processed with zero phase shift spectral filters, tuned to enhance the action potential onset, which is sometimes embedded within the sura mating potential. An automatic peak detection and tracking algorithm is then applied to extract latency and amplitude of CAPs. Long-term assessment of the monitoring system was performed during experimental animal surgeries. The system allowed detailed study of the dynamics of CM, CAP and CBF during nerve manipulation and compression.

Digital subtraction method for transient evoked otoacoustic emission recording with ipsilateral noise suppression: an application to stimulus artifact reduction.

The suppression of transient evoked otoacoustic emissions (TEOAEs) by continuous ipsilateral noise masking was investigated to explore the feasibility of its use in the elimination of the acoustical stimulus artifact. A reference noise template was obtained by stimulating the ear with identically reproducible digitally synthesized broadband noise. The same noise was used to suppress a TEOAE generated by an ipsilaterally presented click under the same conditions. Digital subtraction of the reference noise from the noise-suppressed TEOAE resulted in obtaining a template of a click artifact for that ear. The results have shown that the digital subtraction method cancels the suppressor noise, enabling the observation of the suppressed TEOAE. The subtraction of the stimulus artifact template from the original TEOAE allowed the recovery of the emission waveform with substantially reduced stimulus artifact, thus enabling the recovery of high-frequency otoacoustic emission components.

Adaptive noise cancellation in a multimicrophone system for distortion product otoacoustic emission acquisition.

This study focuses on adaptive noise cancellation (ANC) techniques for the acquisition of distortion product otoacoustic emissions (DPOAEs). Otoacoustic emissions (OAEs) are very low level sounds produced by the outer hair cells of normal cochleas, spontaneously or in response to sound stimulation as a byproduct of a frequency and threshold sensitivity increasing mechanism. Current OAE recording systems rely on test probe noise attenuation and synchronous ensemble averaging for increasing signal-to-noise ratios (SNRs). The efficiency of an ANC algorithm for noise suppression was investigated using three microphones: one placed in the test ear, one in the nontest ear for internal noise reference; one near the subject's head for external noise reference. The system proposed was tested with simulations, off-line averaging and real-time implementation of the ANC algorithm. Simulation results showed that the technique had a potential noise reduction capability of 24 dB for complex multifrequency noise signals. Off-line results were positive, with a mean SNR improvement of 4.9 dB. Real-time results indicated that the use of an ANC algorithm in combination with standard averaging methods can reduce noise levels by as much as 10 dB beyond that obtained with standard noise reduction methods and probe attenuation alone.

Median averaging of auditory brain stem responses.

OBJECTIVE: The primary aim of this study is to demonstrate the feasibility of acquiring auditory evoked potentials (AEPs) by median averaging and study its performance under various recording conditions. The auditory brain stem response (ABR) was used as the AEP of choice because it has the poorest signal to noise ratio (SNR) with inherent high susceptibility to extraneous noise. Secondary aim is to evaluate the characteristics of the median ABRs in comparison with the conventional mean averaged ABRs. DESIGN: Single sweep responses to clicks obtained from four subjects at 5 dB steps were saved in hard disk and used for off-line mean and median averaging. The characteristics of the median averaging technique were investigated by manipulating the averaging procedure using the same set of single sweep recordings and comparing them with the mean averaged responses. The effects of analog to digital input resolution (bit size) was simulated computationally by increasing quantization. RESULTS: The results showed that AEPs with low SNRs such as the ABR can be successfully acquired using median averaging with about the same number of sweeps as was required for mean averaging, provided the EEG signal is digitized with a high number of bits. The resulting waveform generally contained more identifiable waves than the corresponding mean average and had a high-frequency noise superimposed on it. This high-frequency noise was successfully filtered out using a digital, running mean smoothing filter. The median average showed an advantage over the mean average when occasional artifacts were recorded. CONCLUSION: The results showed that ABRs can be acquired successfully by median averaging provided EEG is digitized with high bit size. Compared with conventional mean averaging, median averaging is less sensitive to infrequent, externally and internally generated noise that plagues conventional techniques and may help improve wave identification.

Comparison of the auditory-evoked brainstem response wave I to distortion-product otoacoustic emissions resulting from changes to inner ear blood flow.

OBJECTIVE/HYPOTHESIS: Examine and compare in detail the time courses of the auditory brainstem response (ABR) wave I amplitude and latency to the distortion-product otoacoustic emission (DPOAE) amplitude and phase measured in the rabbit model following deliberate obstruction of cochlear blood flow (CBF). METHODS: Using a posterior fossa craniotomy in five rabbits, the internal auditory artery (IAA) was compressed with a probe. ABR and otoacoustic emission were continuously monitored before, during, and after the compressions. RESULTS: ABR wave I amplitudes demonstrated measurable decreases at a mean of 28.3 s after IAA compression, whereas DPOAE amplitudes decreased after a mean of 14.8 s. Wave I latencies began to increase at a mean of 18.3 s after occlusion, while DPOAE phase measures changed after a mean of only 4.8 s following IAA compression. The time-course patterns were similar for the amplitudes of both ABR wave I and DPOAE. CONCLUSIONS: ABR wave I amplitude follows a similar, though delayed (by approximately 10 s) time-course pattern to that of the DPOAE following IAA compression. The implication of these findings for intraoperative auditory monitoring is that changes in many currently employed measures will lag actual surgically induced alterations in CBF by at least 20 to 30 s.

Adaptive Wiener filtering for improved acquisition of distortion product otoacoustic emissions.

An innovative acoustic noise canceling method using adaptive Wiener filtering (AWF) was developed for improved acquisition of distortion product otoacoustic emissions (DPOAEs). The system used one microphone placed in the test ear for the primary signal. Noise reference signals were obtained from three different sources: (a) pre-stimulus response from the test ear microphone, (b) post-stimulus response from a microphone placed near the head of the subject and (c) post-stimulus response obtained from a microphone placed in the subject's nontest ear. In order to improve spectral estimation, block averaging of a different number of single sweep responses was used. DPOAE data were obtained from 11 ears of healthy newborns in a well-baby nursery of a hospital under typical noise conditions. Simultaneously obtained recordings from all three microphones were digitized, stored and processed off-line to evaluate the effects of AWF with respect to DPOAE detection and signal-to-noise ratio (SNR) improvement. Results show that compared to standard DPOAE processing, AWF improved signal detection and improved SNR.

Detection of spikes with artificial neural networks using raw EEG.

Artificial neural networks (ANN) using raw electroencephalogram (EEG) data were developed and tested off-line to detect transient epileptiform discharges (spike and spike/wave) and EMG activity in an ongoing EEG. In the present study, a feedforward ANN with a variable number of input and hidden layer units and two output units was used to optimize the detection system. The ANN system was trained and tested with the backpropagation algorithm using a large data set of exemplars. The effects of different EEG time windows and the number of hidden layer neurons were examined using rigorous statistical tests for optimum detection sensitivity and selectivity. The best ANN configuration occurred with an input time window of 150 msec (30 input units) and six hidden layer neurons. This input interval contained information on the wave component of the epileptiform discharge which improved detection. Two-dimensional receiver operating curves were developed to define the optimum threshold parameters for best detection. Comparison with previous networks using raw EEG showed improvement in both sensitivity and selectivity. This study showed that raw EEG can be successfully used to train ANNs to detect epileptogenic discharges with a high success rate without resorting to experimenter-selected parameters which may limit the efficiency of the system.

Time-frequency distribution of evoked otoacoustic emissions.

Otoacoustic emissions (OAE) are non-stationary signals that vary in time depending on the characteristics of the stimulus. Traditional spectral analysis using Fourier methods ignores the effects of time and can miss important temporal information. Therefore, a better form of spectral analysis requires the use of time-frequency distribution methods. Traditionally, short time Fourier transforms (STFT), commonly known as spectrograms, are used to provide such time-frequency representations. STFT however, suffer from poor resolution and do not provide enough detail about the characteristics of the emissions. In this study, recently developed time-frequency distributions, the Wigner Distribution (WD) and the Choi-Williams Distribution (CWD) are investigated to provide high resolution representations of transient evoked OAEs. Although WD has excellent properties for time-frequency analysis, it suffers from cross-term artefacts generated when multiple sinusoids are present. CWD provides a solution to this problem at the expense of poor time and frequency support. In this study, we use both distributions to estimate the cross-products and provide a relatively artefact-free time-frequency distribution of OAEs. This method is applied to both click and tone burst evoked OAE and shows a more detailed time-frequency representation with as many crests and valleys as different latencies.

Measurement of signal and noise characteristics in ongoing auditory brainstem response averaging.

Although diagnostic testing with auditory evoked potentials (EPs) has become routine, quantitative measurements of signal and noise are still lacking. In this study, current signal, power, noise power, and signal-to-noise ratio (SNR) estimation formulas are reviewed and applied to auditory brainstem response averaging. Single-sweep responses to individual sound stimuli are recorded and estimation formulas are evaluated during off-line averaging under various sound level and noise conditions. The results show that the quality of the averaged EP can be quantitatively assessed by the continuous display of the SNR and residual noise estimates during the averaging process. This method also allows the study of different types of averaging techniques to improve EP response acquisition.